Abstract and Introduction
Abstract
The majority of women gain more weight during pregnancy than what is recommended. Since gestational weight gain is related to short and long-term maternal health outcomes, it is important to identify women at greater risk of not adhering to guidelines. The objective of this study was to examine the relationship between body image and gestational weight gain. The Body Image Assessment for Obesity tool was used to measure ideal and current body sizes in 1,192 women participating in the Pregnancy, Infection and Nutrition Study. Descriptive and multivariable techniques were used to assess the effects of ideal body size and discrepancy score (current—ideal body sizes), which reflected the level of body dissatisfaction, on gestational weight gain. Women who preferred to be thinner had increased risk of excessive gain if they started the pregnancy at a BMI ≤26 kg/m but a decreased risk if they were overweight or obese. Comparing those who preferred thin body silhouettes to those who preferred average size silhouettes, low income women had increased risk of inadequate weight gain [RR = 1.76 (1.08, 2.88)] while those with lower education were at risk of excessive gain [RR = 1.11 (1.00, 1.22)]. Our results revealed that body image was associated with gestational weight gain but the relationship is complex. Identifying factors that affect whether certain women are at greater risk of gaining outside of guidelines may improve our ability to decrease pregnancy-related health problems.
Introduction
More than half of all women in the United States are overweight or obese. In the last 25 years, we have seen a 16% increase in obesity prevalence among women of childbearing age. It has been hypothesized that one of the reasons for this increase is the greater amount of weight women have been allowed to gain during pregnancy. From observational studies conducted in the US, roughly 30–40% of women gain weight within the recommended ranges, 20% gain less, and 40–50% gain more than what is recommended. Women with excessive weight gain are less likely to lose this weight in the postpartum period and may, consequently, be at greater risk of beginning the next pregnancy at a higher weight status as well as have an increased risk of obesity later in life.
Gaining weight outside of recommended ranges can result in poorer birth outcomes due to increased maternal and fetal complications. For example, excessive weight gain is associated with increased risk of caesarean section and macrosomia while inadequate weight gain can result in a low-for-gestational age infant and preterm birth. In 1990, the Institute of Medicine (IOM) established recommendations for weight gain during pregnancy based on prepregnancy body mass index (BMI). The recommended weight gains according to prepregnancy BMI categories are as follows: 12.5–18 kg (28–40 lbs.) for women who start the pregnancy underweight (BMI <19.8 kg/m), 11.5–16 kg (25–35 lbs.) for normal weight women (BMI of 19.8–26.0 kg/m), 7–11.5 kg (15–25 lbs.) for overweight women (BMI of 26.0–29.0 kg/m), and a weight gain of at least 6.8 kg (15 lbs.) for obese women (BMI >29.0 kg/m). Given the importance of adequate weight gain during pregnancy, it is becoming increasingly important to identify women at risk of gaining weight outside of recommended ranges.
Pregnancy is the only time in a woman's life when weight gain is encouraged and expected. The relationship between body image, which is a person's perception of or attitude towards his or her own body, and weight-related concerns in the nonpregnant state suggests that body image may be related to weight gain during pregnancy, a time of immense physical and physiological changes. For example, a recent study found that women who were obese before pregnancy had greater weight and shape concerns before and during pregnancy than nonobese women. In this study, we determined whether women who are more dissatisfied with their body shape and size before pregnancy are at higher risk of gaining outside of the recommended weight guidelines than women who are more comfortable with their body.
Perceptions and preferences related to body shape and size are thought to differ for Caucasians and African Americans. Previous research suggests that African American women are much more likely to prefer a larger body size compared to Caucasian women and that there are cultural norms within the African American community that support higher satisfaction with weight and appearance. Given these potential racial differences in body image, we examined whether race influences the effect of body image on gestational weight gain.
The relationship between body image preference and weight gain during pregnancy has not been explored sufficiently. Data from the Pregnancy, Infection and Nutrition study (PIN) was used to examine the following questions: (1) how does ideal body size preference relate to gaining weight according to IOM guidelines and (2) are women with greater body dissatisfaction more likely to gain outside of IOM-recommended ranges and is this relationship different for African American and Caucasian women? By identifying factors that affect whether certain women are at greater risk of gaining excessively or inadequately during pregnancy, we can potentially improve our ability to decrease pregnancy-related health problems for both mother and child.